Individual
MELISSA GODBOLT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1123 SANDY BLUFF RD, MULLINS, SC 29574-4215
(843) 464-3760
Mailing address
1123 SANDY BLUFF RD, MULLINS, SC 29574-4215
Taxonomy
Speciality
Code
Description
License number
State
225C00000X
Rehabilitation Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
45-5423078
—
SC
Enumeration date
12/03/2018
Last updated
12/03/2018
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